The Office of the National Coordinator for Health Information Technology Health IT Playbook

Section 1

Electronic Health Records

Which phase of the EHR adoption process are you currently in?

Adoption of electronic health records (EHRs) has increased tremendously in the United States following the Health Information Technology for Economic and Clinical Health (HITECH) Act and the Centers for Medicare and Medicaid Services (CMS) EHR Incentive Program.

EHRs are real-time, patient-centered records. They make health information available instantly and securely to authorized users “whenever and wherever it is needed”. EHRs help you streamline your workplace and improve the quality of care you provide. They also make it easier to update information and exchange data with other care providers.

EHR adoption carries great potential but can present challenges to the clinical organization undergoing the transitioning, whether from another electronic or paper based system. Most clinicians agree that implementing EHRs is an ongoing journey. There is no single destination or end, as there’s always the opportunity to optimize workflows or improve the use of data. This section provides resources to guide you along the EHR journey, from planning to selection of a vendor, to contracting with a vendor, to implementing and adopting an EHR, and then arriving at the first “destination” of using an EHR.

After some time at this first destination, it’s time to think about how your workflows can improve and optimize your EHR. This is the ongoing part of the journey that can start again each time you adopt additional health IT solutions, such as a patient portal, connect to an HIE, or use your EHR to participate in value-based care or new payment models. Within this Playbook you will find information on a variety of health IT topics that can serve as a starting point for further study. The tools and resources included within this Playbook leverage lessons learned from years of implementation experience across a wide variety of clinical settings. Use the Playbook to navigate and select the tools that are most relevant to your EHR adoption journey.

EHR Contracts Untangled: Selecting Wisely, Negotiating Terms, and Understanding the Fine Print

Summary: Selecting and negotiating the purchase or upgrading of an EHR is a challenging undertaking for any health care provider. This guide equips providers, their business managers, and their advisors with key knowledge and insights that will help them select appropriate technologies, navigate the acquisition process, and negotiate contract terms that can minimize potential problems and create a more beneficial and balanced relationship with their health IT vendor. The guide will also assist providers who may be considering upgrading their current EHR—such as to meet new certification requirements—or integrating new modules, capabilities, or services.

Part A of the guide highlights some of the critical planning steps that all providers should take to properly understand and communicate their requirements to potential vendors. Areas addressed include:

  • Types of EHR products and service models
  • Researching and comparing EHR products and vendors
  • Identifying and prioritizing your EHR’s technical and operational requirements
  • Due Diligence: Finding the best EHR for your needs
  • Understanding certification and regulatory requirements
  • Procurement strategy, planning and resourcing

Part B of the guide focuses on the negotiation and contracting phase of acquiring an EHR. It contains strategies and recommendations for negotiating best practice EHR contract terms. It also illustrates how legal issues might be addressed in a contract by providing example contract language. Topics include:

  • EHR Safety and Security: A Shared Responsibility
  • System Performance: Ensuring Your EHR Meets Your Expectations
  • Data Rights: Managing and Safeguarding EHR Data
  • Fostering Interoperability and Integration
  • Intellectual Property Issues
  • Managing Risks and Liability
  • Dispute Resolution: Resolving Disagreements With Your EHR Vendor
  • Transition Issues: Switching EHRs

Important Disclaimer

This document should not be construed as legal advice and does not address all possible legal and other issues that may arise with the acquisition of an EHR. Because every healthcare provider organization is unique with respect to its operations, priorities, resources and IT infrastructure, your purchase, implementation and use of an EHR will present issues specific to your practice or organization that cannot be contemplated or addressed in this guide. We strongly encourage you to obtain the advice of an experienced attorney whenever you are proposing to enter into a legally binding agreement for health IT products or services.

Electronic Health Records Contract Guide

EHR Contract Guide cover

Overview
Provides critical planning and negotiation steps to properly understand and communicate a practice’s EHR requirements with examples of contract language and terms

Who it’s for
Providers, Business/Office Managers

When it’s used
When Selecting and negotiating the purchase of an EHR

Download Electronic Health Records Contract Guide [PDF - 798 KB]

Summary: Find tools to help you and your practice assess readiness, create a leadership team for implementation, and set goals to assist decision-making during implementation. Use vendor comparison and selection tools to help choose the right system for your practice.

A decision to implement an EHR requires a considerable amount of time. Before embarking on an EHR implementation project, it is important to have realistic expectations. Impediments to adoption include the difficulty of understanding the information needs, the uncertain cost implications, and intense efforts required to identify and implement a system.

To overcome implementation obstacles, it is important to understand what the EHR will bring to a practice before the process is started. Readiness is a key success factor along with the eagerness of personnel, availability of a champion, perceived usefulness of the EHR, and teamwork. Planning must address the initial and ongoing effect of EHR implementation on the clinical practice.

Once the members of the practice define how they would like their practice to work in the future using an EHR, they are ready to begin the selection phase. Deciding whether to move to an EHR and which system to use also takes planning and requires a systematic decision-making approach. You must understand both the practice needs and the capabilities of the EHR systems on the market to find a system that can adequately meet those needs.

EHR Demonstration Scenario, Evaluation and Vendor Questions

EHR Demo cover

Overview
Helps providers and health IT implementers understand vendor capabilities through established scenarios

Who it’s for
Providers and health IT implementers

When it’s used
When selecting or upgrading to a certified EHR vendor

Download EHR Demonstration Scenario, Evaluation and Vendor Questions [PDF - 602 KB]

EHR Selection Education

EHR Selection Education cover

Overview
Provides education on EHR selection; Includes definition of common IT terms, hardware and software considerations

Who it’s for
Providers, health IT implementers

When it’s used
When selecting or upgrading an EHR

Download EHR Selection Education [PDF - 742 KB]

EHR System Testing Plan

EHR System Testing Plan cover

Overview
Contains types of tests performed on EHRs

Who it’s for
Providers and health IT implementers

When it’s used
When sampling various EHR vendor systems in the selection process to learn how their particular system works

Download EHR System Testing Plan [PDF - 533 KB]

Vendor Comparison Tool

Vendor Comparison Tool cover

Overview
Provides guidelines for questions to ask EHR vendors during demos including how their systems meet Meaningful Use objectives

Who it’s for
Providers, practice managers, health IT implementers

When it’s used
When planning for and selecting an EHR

Download Vendor Comparison Tool [PDF - 336 KB]

Vendor Pricing Template

Vendor Pricing Template

Overview
Defines line item costs used in EHR software purchase, implementation, training, and support for both vendor licensing models and vendor SAAS models so practices can produce a cost comparison among candidate vendors

Who it’s for
EHR implementation lead, practice manager, finance lead

When it’s used
When planning for, selecting, and contracting for an EHR

Download Vendor Pricing Template [XLSX - 102 KB]

Cloud-based EHRs

Summary: Cloud computing can be basically thought of as a model for enabling scalable on-demand access to IT services, such as an EHR that can be rapidly provisioned and released with minimal management effort and cost.

The most common benefits of using Cloud-based EHRs are a reduction in upfront IT investments in hardware and software purchases, and reduction in on-going maintenance cost. This enables providers to start small and increase their IT allocations as required. Additionally, cloud environments typically are able to provide much higher levels of availability of IT services than in-house IT services, and thus able to further reduce unanticipated runtime failures in EHRs.

However, there are risks and challenges that must be carefully considered by providers before using Cloud-based EHRs. The responsibility of data security becomes shared responsibility with the Cloud provider and needs to be well understood. Additionally, providers’ level of access and control of the information stored in the cloud based EHR would be lower than that of an on-premise EHR system. Legal contracts and appropriate service level agreements with the cloud provider and on-going monitoring can mitigate these risks and issues.

Summary: Find guidelines on how to implement an EHR, including supporting activities such as training, mock go-lives, and system testing.

Successful EHR implementation will help you get the most out of your system. The steps in the pre-implementation phase include: establishing a governance process and a project plan; communicating with and involving both staff and patients; redesigning workflows; and providing education and training.

The implementation process includes: tailoring the system to meet practice requirements; establishing a change management process; determining how to backload medical histories of patients, accounting for staff time required to learn and use the system with patients; implementing and supporting the system; and encouraging the practice along the way.

Change Management in EHR Implementation

Change Management in EHR Implementation cover

Overview
Explains basic change management principles and why managing change effectively is important for successful EHR implementation

Who it’s for
Providers and health IT implementers

When it’s used
Before and during EHR implementation

Download Change Management in EHR Implementation [PDF - 597 KB]

Chart Migration and Scanning Checklist

Chart Migration Checklist cover

Overview
Provides guidelines for determining what information from the paper record is needed to be imported into the EHR

Who it’s for
EHR implementation lead, practice manager, clinical lead

When it’s used
When planning for an EHR implementation, when conducting a paper to EHR migration

Download Chart Migration and Scanning Checklist [PDF - 597 KB]

Creating a Leadership Team for Successful EHR Implementation

Creating a Leadership Team for Successful EHR Implementation cover

Overview
Provides various members and role descriptions important to the leadership team creation process with a template for a practice to use to create their own

Who it’s for
Providers and health IT implementers

When it’s used
When considering implementing an EHR

Download Creating a Leadership Team for Successful EHR Implementation [PDF - 487 KB]

Defining Goals and Objectives for EHR Implementation

Defining Goals and Objectives for EHR Implementation cover

Overview
Provides guidelines for establishing realistic and measureable goals and objectives for EHR implementation to aid in its success

Who it’s for
Providers and health IT implementers

When it’s used
When planning for and during an EHR implementation

Download Defining Goals and Objectives for EHR Implementation [PDF - 628 KB]

Summary: Find tools to help you use the functions of your EHR to more efficiently deliver quality care to your patient panel.

This phase involves evaluating both the implementation process as well as the impact of the implementation on the practice. Questions to consider include:

  • Did the implementation process occur smoothly?
  • Did everyone in the practice participate and feel involved? Did events occur as planned?
  • What were the strengths and weaknesses of the implementation?
  • What is the impact on workflow in the practice? Are there opportunities for improvement?

The purpose of an evaluation is to learn what worked well and what did not work during the implementation to either avoid repeating mistakes in the future or to follow a similar path to success at a later time. It is important to recognize that although a significant milestone on a long journey has been met, the journey will still continue. An evaluation provides the foundation for charting the future journey and serves as an acknowledgement that there is an opportunity and commitment to improve upon the value of an EHR.

Learning Guide: Driving Clinical Transformation in a Practice Setting with Health IT

Driving Clinical Transformation in a Practice Setting cover

Overview
A learning guide that shows how health information technology can drive clinical transformation in a practice

Who it’s for
Individual practices, communities, and learning collaborative organizers interested in using health IT to improve practice performance and care management

When it’s used
To educate about using health IT to improve practice performance and care management

Download Learning Guide: Driving Clinical Transformation in a Practice Setting with Health IT [PDF - 382 KB]

Workflow Assessment for Health IT Toolkit

Overview
A toolkit designed for the planning, design, implementation, and use of health IT in ambulatory care

Who it’s for
Providers, IT support staff, practice managers

When it’s used
When seeking tips and guidance for addressing clinical and administrative workflow concerns

Visit the Workflow Assessment for Health IT Toolkit site

Workflow Redesign Templates for EHR Implementation

Workflow Redesign Templates for EHR Implementation cover

Overview
Provides guidelines for workflow process mapping to optimize EHR efficiency

Who it’s for
Providers, practice managers, clinic staff

When it’s used
When planning for and during EHR implementation

Download Workflow Redesign Templates for EHR Implementation [PDF - 569 KB]

Consolidated Clinical Document Architecture (C-CDA)

If you have received a “Summary of Care” document or created a “Discharge Summary” for your patient, you have in fact used a C-CDA document. C-CDA stands for Consolidated Clinical Document Architecture, and is an industry standard used by EHRs to exchange patients’ clinical information among providers and patients. The various types of documents used by providers such as Consultation Notes, Summary of Care, History and Physical and Discharge Summary, are all specialized types of C-CDA.

C-CDA Scorecard

The C-CDA Scorecard is a web based tool developed specifically for providers, so that providers can quickly assess the quality and clarity of information in the clinical documents that they receive before reading the entire document. A high score (>90) from the C-CDA Scorecard indicates that the information in the clinical document has been formatted in a way that would enable providers to understand the clinical information accurately. On the other hand, a low score (<70) would let providers know immediately that the information perhaps is not complete and that additional effort may be needed in order to appropriately make sense of the information. This tool will help providers ensure that they receive high quality clinical information when working with the EHR vendors. Providers should pass this tool on to their health IT implementer or support team for use. If the C-CDA scores low with this tool the intent is for providers to work with their vendor or IT team to optimize.

Improving Care Coordination Using Consolidated Clinical Document Architecture (C-CDA) Scorecard

Overview
Explains how to test the quality of Summary of Care Content received during transition of care with the goal of improving care coordination

Who it’s for
Eligible professionals, eligible hospitals, critical access hospitals

When it’s used
When receiving summary of care electronically from a hospital or referring provider during transition of care

Visit the Improving Care Coordination Using Consolidated Clinical Document Architecture (C-CDA) Scorecard site

Summary: Learn the steps that you need to follow to ensure a smooth transition and that the data and knowledge that you have captured in your current EHR can be migrated to and used in your new EHR.

There are many reasons why you may choose to replace an EHR such as outgrowing the capabilities of your first EHR, expanding your practice, or joining another practice. Just as migrating from paper documentation to an EHR required careful planning and preparation, migrating from one electronic environment to another should be carefully planned to ensure that historical data are both integrated and accessible from your new EHR. Chapter 9 of the EHR Contract Guide provides specific guidance for the transition to a new EHR vendor, including length of support, data portability, software license, transition support services and data transfer and conversion. Examples of contract language and terms are also provided.

EHR Contract Guide Chapter 9: Transition Issues: Switching EHRs

EHR Contract Guide Chapter 9: Transition Issues: Switching EHRs cover

Overview
Provides critical planning and negotiation steps to properly understand and communicate a practice’s EHR requirements with examples of contract language and terms

Who it’s for
Providers, Business/Office Managers

When it’s used
When switching EHRs

Download EHR Contract Guide Chapter 9: Transition Issues: Switching EHRs [PDF - 117 KB]

We will be adding tools and resources to this section of the Playbook in future updates. Have a tool or resource to share? Please let us know by providing your feedback below.

Section 1 Recap

Start the health IT journey by adopting electronic health records.

  • Understand EHR contracts
  • Select an EHR
  • Adopt and implement your EHR
  • Optimize your workflow
  • Migrate your data

Join the conversation.

Let us know how we can improve and expand on Electronic Health Records.

Content last updated on: January 23, 2017